Provider Demographics
NPI:1477804060
Name:STASCAVAGE, NARDY (CRNA)
Entity Type:Individual
Prefix:
First Name:NARDY
Middle Name:
Last Name:STASCAVAGE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:MT
Mailing Address - Zip Code:59872-9618
Mailing Address - Country:US
Mailing Address - Phone:406-822-4841
Mailing Address - Fax:406-822-4963
Practice Address - Street 1:1208 6TH AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:MT
Practice Address - Zip Code:59872-9618
Practice Address - Country:US
Practice Address - Phone:406-822-4841
Practice Address - Fax:406-822-4963
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9568163WX0800X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology